Infection of the trachea associated with airway inflammation and obstruction

  • Acute tracheitis: sudden onset; higher morbidity and mortality
  • Subacute tracheitis: indolent presentation and course; more common among children with prolonged intubation, tracheostomy, and/or underlying respiratory or neurologic conditions


  • Viral prodrome common
  • Increased incidence during viral respiratory season (fall and winter): up to 75% coinfected with influenza A
  • Gender predisposition unclear (1.3:1 male-to-female ratio has been reported.)
  • 2–3% mortality rate

Risk Factors

  • Antecedent viral infection, especially croup
  • Tracheal trauma

General Prevention

  • Routine childhood immunization with Haemophilus influenzae type b, influenza, measles, and pneumococcal vaccines
  • Avoid overaggressive suctioning of children with artificial airways.


  • Epithelial damage from a viral infection or mechanical trauma (e.g., endotracheal intubation, surgical procedure) occurs in the trachea at the level of the cricoid cartilage. As a result, the damaged tissue is more susceptible to bacterial superinfection.
  • Mucosal damage characterized by marked subglottic edema, copious purulent secretions, and a pseudomembrane (mucosal lining, inflammatory products, and bacteria). These changes lead to marked airway obstruction.
  • Toxic shock syndrome may be a consequence if the infection is associated with toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes.


  • Bacteria
    • S. aureus (most common), group A β-hemolytic Streptococcus, Moraxella catarrhalis, nontypeable H. influenzae, Streptococcus pneumoniae
    • Pseudomonas aeruginosa and other gram-negative enteric bacteria have been associated with health care–associated infections.
    • Mycobacterium tuberculosis, Mycoplasma pneumoniae, Corynebacterium diphtheriae, H. influenzae type b, and respiratory anaerobic bacteria are uncommon pathogens.
  • Viruses: Influenza, parainfluenza, respiratory syncytial, herpes simplex, and measles viruses have been found with bacterial pathogen(s).
  • Fungi: seen with underlying immunodeficiency disorders or chronic steroid use

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